What is dihydroergotamine?
Dihydroergotamine affects vasoconstriction (narrowing of arteries and veins). Dihydroergotamine also affects blood flow patterns that are associated with vascular headaches. Dihydroergotamine is used to prevent and to treat vascular headaches such as migraine and cluster headaches. Dihydroergotamine may also be used for purposes other than those listed in this medication guide.
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What are the possible side effects of dihydroergotamine?
Stop taking dihydroergotamine and seek emergency medical attention or contact your
doctor immediately if you experience.
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an allergic reaction (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; or hives);
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chest pain;
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numbness or tingling in the fingers or toes;
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muscle pain in the arms or legs;
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leg weakness;
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changes in heart rate;
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swelling; or
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itching.
Other, less serious side effects may also occur. Continue to take
dihydroergotamine and talk to your doctor if you experience nausea or vomiting.
Dihydroergotamine may be habit forming when used for long periods of time. Larger
doses may be needed for headache relief, and withdrawal effects may occur when ergotamine
therapy is stopped.
Side effects other than those listed here may also occur. Talk to your doctor about any side
effect that seems unusual or that is especially bothersome.
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How should I use dihydroergotamine?
Use dihydroergotamine exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. Use the first dose of dihydroergotamine at the first sign of a headache. For the injectable form of dihydroergotamine, inject up to 1 mg (1 mL) as directed at the first sign of a headache. Two additional doses can be given at 1 hour intervals up to a total of 3 mg (3 mL). Doses smaller than 3 mg may be effective. Do not use more than 3 mg in any 24-hour period. Do not use more than 6 mg in any 7 days. If your symptoms are not being adequately treated, see your doctor.
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What is the most important information I should know about dihydroergotamine?
Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. Some, but not all, of these medications are listed below in the section "What other drugs will affect dihydroergotamine?". Do not take any other medications during treatment with dihydroergotamine without first talking to your doctor. Notify your doctor immediately if you experience an irregular heartbeat; nausea; vomiting; weakness; or coldness, numbness, or pain in the hands, feet, arms, or legs.
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What happens if I miss a dose?
Since dihydroergotamine is used on an as-needed basis, missing a dose is not usually a problem.
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What other drugs will affect dihydroergotamine?
Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. The following drugs should not be taken with dihydroergotamine or should be used only under the close supervision of a doctor: another medication that contains an ergot compound such as Ergomar, D.H.E., or D.H.E. Nasal; another migraine headache medicine such as almotriptan (Axert), sumatriptan (Imitrex), zolmitriptan (Zomig), rizatriptan (Maxalt), or naratriptan (Amerge)--these medicines must not be taken within 24 hours of a dose of dihydroergotamine;
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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?
Dihydroergotamine has been assigned to pregnancy category X by the FDA. Animal studies have revealed evidence of developmental toxicity including decreased fetal body weights and/or skeletal ossification, delayed skeletal ossification, and impaired reproductive function (decreased mating indices) in the offspring. There are no controlled data in human pregnancy. Dihydroergotamine is considered contraindicated for use during pregnancy.
DIhydroergotamine-induced intrauterine growth retardation has been attributed to reduced uteroplacental blood flow resulting from prolonged vasoconstriction of the uterine vessels and/or increased myometrial tone.
There are no data on the excretion of dihydroergotamine into human milk. The American Academy of Pediatrics has no position on the use of dihydroergotamine during breast-feeding, but considers use of the closely related compound, ergotamine, to be contraindicated.
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Who should NOT use this medication?
- Known or suspected pregnancy and in nursing women.
- Concomitant therapy with peripheral or central vasoconstrictors or potent CYP3A4 inhibitors; recent (i.e., 24 hours) therapy with a 5-HT1 receptor agonist (e.g., sumatriptan) or an ergot alkaloid (e.g., ergotamine, methysergide). (See Interactions.)
- Known or suspected ischemic heart disease (e.g., angina pectoris, history of myocardial infarction, documented silent ischemia) or coronary artery vasospasm (e.g., Prinzmetal variant angina).
- Known peripheral arterial disease, uncontrolled hypertension, or following vascular surgery.
- Severe hepatic or renal impairment.
- Sepsis.
- Basilar or hemiplegic migraine.
- Known hypersensitivity to ergot alkaloids.
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What does my medication look like?
Dihydroergotamine is available with a prescription under the brand name D.H.E. in 1 mg per 1 mL ampules for injection. Other brand or generic formulations may also be available. Ask your pharmacist any questions you have about this medication, especially if it is new to you.
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What happens if I overdose?
Seek emergency medical attention. Symptoms of a dihydroergotamine overdose include nausea, vomiting, weakness, muscle pain, numbness in your fingers or toes, gangrene, itching, confusion, drowsiness, convulsions, and possibly death.
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What should I discuss with my healthcare provider before using dihydroergotamine?
Some medications may increase the risk of dangerously decreased blood flow to the brain, heart, or extremities when taken with dihydroergotamine. In rare but severe cases, gangrene or other serious problems can result. Some, but not all, of these medications are listed below in the section "What other drugs will affect dihydroergotamine?". Do not take any other medications during treatment with dihydroergotamine without first talking to your doctor. Do not use dihydroergotamine without first talking to your doctor if you have
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Can I stop taking the medication if I feel better?
If you are taking an analgesic for pain and you are no longer experiencing the pain you may stop using the medication. In general, pain medications are to be used on an as needed basis.
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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.
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Where can I get more information?
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